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The knock of the knot – Breast Cancer with Lacanian Angles

Facing Magazine 2010 Again

Transported back to wait for the next step I soaked up my wholeness. More than me, I had additions. Semi-cyborg! A Seven of Nine with all her thoracic metal implants! I tucked the blankets around my knees again. Those old glossy magazines smiling, grinning knowingly at my side. A wide berth. Who would touch them? And who do I tell that their existence was rather abhorrent. The bustle of medical staff in and around the corridors. If those magazines could tell their tale. How many patients in the last five years? How much weight of patience and emotional if not physical pain was held in this corridor, contained here and seen awry by the existence of such old magazines. They’d survived the duration, not even dogeared. Or perhaps some kindly soul had just recently left these magazines as a good will gesture. But five years since they’d been published. How many millions of births and indeed deaths since then. How many graduations, retirements, parties, partings? How many therapeutic hands had grappled with a condemned cancerous breast. How many daily squirts of antibacterial gel? How many others have recoiled at the magazines from 2010?

Mama Mia – Mammary mia!

Almost immediately a new team member in yet another white coat led me into a small room with a lethal radioactive sign looming on its door. Mammogram time! This time to record the position of the wire which acts as the tumor marker. The wire localization is for the surgeon to use the wire as a guide to locate and remove the tumor. During surgery the wire will also be removed. Stripped above the waist the vertical contortion began. Thank goodness for the desensitized breast asleep with its heavy dose of local anaesthetic. Oblivious to the wire inside as I moved it around. The struggle that women of a certain cup size know only too well. A mammogram dance of breast, shoulders, chin, arms and moving the other breast away to stop its natural tendency to sit squarely adjacent to its injured twin like a sympathetic watchman. Oh yes you younger readers what joys arrive with middle age protocols. Scorned for moving my hand the radiologist bid me to stay still. Yet she was clearly relieved to see me remove the unwanted alright breast (the wrong breast not the wronged breast) from the picture-frame to come. The radiographer slipped behind her screen. She was the observer, no hands-on for her. Watch the birdie, say cheese.

A click click accompanied by a gasp of failure, irritation towards a failed irradiation. Of course the wire was so high up under the arm, it was out of shot. A new photo-session commenced. This time at a more appropriate sideways angle. Like a David Bailey model standing square, half naked in a surgical gown posing to the commands: chin high, shoulder back, stomach tensed, jaw relaxed. A tight vice like squeeze. Who knows what was happening inside, but the local anaesthetic was so recently administered that pain was not part of the experience. Permitted to sneak a peek I saw the three images. Two of which had captured the wire insertion.

Outside in the corridor the pile of magazines lay untouched. Possibly untouched over the course of five years. Me done and dusted I waited in the wings for Michael, my guardian. It was a cool forty minute wait. I eyed the smiling magazines, they smiled in return as I nestled into the blankets. Composed and trustful, awaiting the next step and the procedure that lay ahead, back there on the surgical ward.

Speed and dope

Busy Michael returned as my loyal escort at almost ten o’clock. No longer hugging my several accumulated blankets quite so tightly I was returned to the ward and my bed by the window in the female bay. I wanted to text home, to report the success of the wire-insertion. Amazed that the procedure was over. It was a bright October morning. Sunlight poured through the window. Seconds after sitting down there was no time to contemplate because my blood pressure needed to be taken. Next the cannula team approached. As I suspected my veins had retracted under my skin. Typically not to be found in my arms, never in my arms, not by hook nor crook nor to my surprise in my hands. Before I could react, the largest most muscular team-member swooped over my shoulder (across the side I’d been protecting) and grabbed my forearm. With both hands bearing down upon the thin flesh protecting my radius and ulna he explained that if he squeezed (which he did with much skill) the veins would most certainly pop up and indeed they did. With no more ado the needle was inside the vein and the cannula was expertly fixed to the back of my hand. Someone approached with a label for my rucksack and in the next moment I’d been received by the anaesthetist. Moments later there was a short walk to the surgical room. Yes there would be time for a final trip to the toilet, how relieving, I’d drunk so much water, in preparation, the midnight before. I found myself led into the adjacent room perched and on the medical bed slipping my arms out of the gown as instructed. There was still time. Time to be introduced to members of the team. I was in the ante-room and the anaesthetic was being attached. I was introduced to students, did I mind, no, how could I? When would the blue-dye be administered? Just before surgery, not to worry.

A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed and examined to determine whether cancer cells are present. Early yesterday morning the injection of radioactive liquid, or tracer, was administered. Once under anaesthetic the blue-dye is immediately injected into the breast and it adheres to the radioactive tracer to easily locate the sentinel lymph node. A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from the primary tumor.

The surgical team watch as the dye collects in the first lymph nodes. This process oflymph node mappingassists swift and accurate identification of the cells. The surgeon removes about 1 to 3 of these nodes and sends them to be analysed to see if they contain cancer cells. A negative SLNB result will suggest that the cancer has not spread to the nearby lymph nodes or on to other organs. A positive SLNB result indicates the contrary, that cancer is present in the sentinel lymph nodes and may also have spread to regional lymph nodes and possibly other organs. With this information the laboratory report will help the surgical team determine the stage of the cancer and the extent of disease within the body in order to develop an appropriate treatment plan.

Back in the room, my underwear was riding up. Could I wriggle it downward. I fidgeted, would it make any difference at all? Would that be the first thing I fixed when I awoke? It was busy in the room ahead, one wheeled out and me wheeled in. Doped, I shifted my head back. It was exactly half past ten.

The knock of the knot – Breast Cancer with Lacanian Angles

Queueing behind the curtain

Soon after our arrival the first batch of patient patients were called by name. Addressed by a woman in crocs hugging a clipboard and chewing a pen. Each already signed off to their fate. Permission slips of all possible legal outcomes acknowledged in ink. I agree to… How they moved: toddling off, a macabre scene in its sombre innocence, as they were led away behind their clinical tour guide. The morning sunlight edged forward casting tubules of fairy dust, as a caretaker rhythmically mopped. Then nothing: an ellipses, ripples on still water. Time in its own dimension of now and then. An anticipation of next and another beat of the heart. Ten minutes later “our” subset were called. A mirror image where they’d gone right, we were led left. Equally obedient, six men and six women. As a member of the latter set once inside we were separated again. Our bay was female. The ladies placed their bags upon their beds. Oh cosy inmates. Each bed, made into a cubicle by a thin curtain tracked by ceiling rails. I was empty handed.

“Alice:How long is forever? White Rabbit:Sometimes, just one second.” ― Lewis Carroll, Alice in Wonderland

Confidently or cluelessly or trustingly, I’d left my “just in case” rucksack in the waiting room with my dedicated personal waiter. Yes I’m very fortunate to have my significant other there awaiting – but the choices leading to what made us “us” are another rambling story of on-line intrigue, anonymity and perseverance. Did he feel the weight of the bag or the weight of the wait? The white coats granted me permission to return – to retrace those steps through heavy security doors. Several long prismatic corridors, sometimes with glaring blinking windows, other times gloomy claustrophobic burrows. Hey I’m back, I escaped the group. My nose twitched: clinical smells. The abandonned mop waited. The rucksack which included the cell phone was held aloft. A final “final kiss” and this Alice chose to start again. Or was I the rabbit? Or was there really any choice at all? Enjoy your jouissance!

Meeting Michael my Chaperone

The curtained bay was cold. A draught from the adjacent window. I watched as my legs took refuge under the blanket provided. Automaton. Self preservation. A nurse came by to take blood pressure and I asked if I was going to have the blue-dye injection or the wire insertion. Blinking I knew the protocol by heart, in theory at least. Ah yes she said, yes, Michael will be here shortly to escort you. I had time to locate the loo and then meet my anaesthetist (another tall white coat) and then Michael arrived, flying in from a previous quest. I imagined him as an invincible Icarus sweeping down valiantly as the plot twists in a medical dystopian version of Brazil.

Magazines Out of Time

In a jot we’d left River View and had entered the specialised breast clinic zone. Michael said to wait. He’d be back. So here I waited. Waiting again but that was fine. It was part of the conveyer-belt process: not too fast. I did what I was told. No need to think. At 8:40 I was spotted and given another blanket. As I sat I fed it between my knees. Me myself and I. I studied the corridor. There on the side table lay magazines. I never had been a fan of those glossies out-of-place in a clinical world. So much for anti-bacterial gel when some of those magazines obscenely revealed their date of issue as being five years previously. Five years. The golden aspiration of those who hope to be survivors or in remission after this bleak diagnosis. Those magazines ensconced in their own timeless gasp of horror.

Rabbit in the wire

Led to the ultrasound and wire insertion room. Upon the surgical couch they discussed how I should lay. The cancer being situated high up, situated in an almost under arm area of breast tissue. This meant that lying flat was not possible. How can they view the eleven o’clock flesh? Those of you who understand or have observed the behaviour of the larger breast will know that once prone they don’t sit pert and neat, aloft on the chest. They relax out and downwards sinking with gravity into the arm pit. They sank and took eleven o’clock along with them, daliesque. As my accused breast sank, so the clinician realised a sideways stance would be the only way. Wriggled into a “recovery” type position my face was still able to glance behind. The ultrasound screen was in view. I wasn’t going to turn into a pillar of salt…frozen in time, that would be too easy an end. This adventure required a willing participation in the suffering ahead. But at least I had a front row seat to view the performance. Let’s repeat: Enjoy your jouissance!

With plenty of reassurance the area was numbed. A local anaesthetic needle glinted and was applied around the areola. Fortunately I’d been quick to ask exactly where that “sharp” was going in. This was déjàvue, I was here only yesterday and I’d read the blogs. I knew the lesson and this lessened the shock. Sharp scratch and it stung like a bee. For those who need details of the level of pain: the depth reached by the needle filled anaesthetic was barely felt, before even more anaesthetic was introduced. The area was numbed, comfortably numb and then came the posturing for the wire. Compliant I was shifted leg and buttock. Next the re-posturing of the breast. The professional with her hands-on-job to move mountains. Like Muhammed if that mountain didn’t come to her she would grasp “it” with more vigor. The guilty “it” that numb part of myself that had betrayed me and led me to here. That apologetic breast which so carelessly, innocently, flaunted cleavage on the beach less than only a month ago. Placing the wire in the flesh of course required some manhandling of the floppity yet fibrous tissues. Manhandle is that an outdated term? Handled like a man, by a woman? Floppity and yet not so floppity. This is dense tissue we’re dealing with here. A lollipop figure. This is tissue with a mind of its own. Tissue that fills tensely according to the hormonal tides. The hands on approach with a push-pull pressure increased to extract the needle after the wire was in place. The experts apologised for their exertion. Almost straddling my body and heave-ho! My, my that was a struggle to retrieve. In my googling I’d already read about this possibility. The shared experience put me at ease. It was a physical effort to achieve and retract but now with the wire in place the needle was out. Pretty painless. The ends of the wire were flattened and taped across my skin. A brooch but not one of valor. I was the receptacle. I contained the treasure, I was the x that marks the spot. I was the prize ready for the next monochrome photo shoot. I didn’t pay much attention to the what, nor the why. No bravery just obedience.